This R01 Stage I study application is in response to NIDA RFA-DA-05-008 (HIV and Drug Abuse Interventions among Pregnant Women in Drug Abuse Treatment). During the five-year project, an Integrated Family and Cognitive-Behavioral HIV Prevention Intervention (IFCBT-HIVPI) manual will be developed for use with pregnant women in drug treatment adapted from Integrated Family and Cognitive- Behavioral Therapy (IFCBT), a multi-systems treatment for adolescent drug abuse with promising efficacy results (Latimer, Winters et al., 2003). The proposed project will also develop an assessment battery and interventionist-training manual. A subsequent randomized controlled pilot-test of IFCBT-HIVPI will be conducted with 126 pregnant women in drug treatment at the Johns Hopkins Center for Addiction and Pregnancy. Pregnant women in drug treatment will be randomly assigned to experimental (i.e., IFCBTHIVPI) and comparison (Brief Psychoeducation Curriculum on HIV Prevention) conditions. The pilot test includes standardized interviews on HIV risk behavior and psychiatric disorders, neuropsychological tests, self-report tools, urine drug testing, and serologic tests of HIV and hepatitis A, B, and C viruses administered at multiple points before (1 baseline assessment), during (2 process assessments), and after (3 outcome assessments) the intervention interval. The pilot test will evaluate the effects of IFCBT-HIVPI on post-intervention HIV incidence, HIV risk behaviors, incidences of hepatitis A, B, and C viruses, educational achievement, and employment. The pilot test will also seek to provide preliminary data on two key issues that will inform subsequent studies of the HIV prevention intervention in the field. First, the pilot test will evaluate the degree to which the development of behavior change processes targeted by IFCBTHIVPI is associated with reduced HIV risk and disease incidence. Second, the pilot test will evaluate the degree to which intervention outcomes vary as a function of participants' neurocognitive, psychiatric, and demographic characteristics. If successful, there are pragmatic public health and clinical practice changes that might emanate from this research. The study has the potential to advance existing HIV prevention science conventions by shedding new light on specific processes of change targeted by family systems and cognitive-behavioral interventions that are responsible for later reductions of HIV risk behavior and HIV incidence among postpartum women in recovery. The proposed examination of neurocognitive, psychiatric, and demographic factors may also help to explain why interventions work for some women but not others. The Stage I study also serves as an initial step in a line of innovative investigations to develop and implement effective HIV prevention models within community-based agencies.